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How to Make a ClaimMaking a Claim under your International Medical Insurance Plan
Please note that this information is provided as generic advice only. All insurers/providers have their own separate claims procedures and their Policy Wordings must be consulted for exact claims advice.
Although each international health insurance provider has their own claims procedures, as a "rule of thumb" there are a number of similar themes that run through most, if not all, plans. It is important to make sure that policyholders are familiar with their insurers own claims process - if they are not followed correctly claims could be delayed or even refused.
If an international medical insurance policy has an excess or deductible this will be taken into account when the claim is settled (ie the insured person may still have a liability to a portion of the claim as agreed when applying for cover). Similarly, some plans and benefits have a system of "co-insurance" or "co-payment" whereby the insured is prepared to pay a set percentage of the costs, rather than a set monetary amount applicable either per year or per claim. |
General Information
Inpatient/Daypatient Claims
This type of claim can be defined as those where there is a requirement for treatment in hospital:
Inpatient Treatment - treatment at a hospital where an insured person is admitted and occupies a bed for one or more nights.
Daypatient Treatment - treatment at a hospital where an insured person is admitted and occupies a bed, but does not remain overnight.
It is a condition of international medical insurance plans that inpatient/daypatient claims are pre-authorised. This means that the insurer/provider should be contacted in advance of treatment and advised as to what treatment is required and at what hospital it will take place. The insurer will then contact the hospital and arrange for any bills to be paid directly by them, thus saving clients from having to pay potentially large treatment costs and then reclaim the money from the insurer.
Worth noting is the fact that some insurers will impose penalties on clients for inpatient/daypatient claims that are not pre-authorised. Whilst the claim may still be settled, it may only be at a percentage of the overall cost (generally this is at about 80%).
There are, of course, circumstances where pre-authorisation is not practically possible - principally in the event of accident and emergency. We at APRIL Medibroker always recommend to our clients that they keep a copy of their insurance documents or membership card with them and also make sure that friends, family or colleagues also have access to them should the client be unable to contact the insurer.
Outpatient Claims
This type of claim is defined as:
Outpatient Treatment - treatment at a hospital, consulting room, or out-patient clinic where an insured person does not occupy a bed.
Under international health insurance plans, this type of treatment does not generally need to be pre-authorised but needs to be paid for by the policyholder and then claimed back from the insurance company.
It is, however, always a good idea to contact the insurance company in advance to check that the required treatment is covered under the terms of the policy.
In order to do this, original itemised invoices and receipts must be obtained from the doctor, therapist etc at the point of treatment/payment. In addition to these documents a claim form needs to be completed by both the insured person and the treating medical practitioner (note that many insurers will not reimburse any charges made by the medical practitioner for completing a claim form). These claims forms are available either from the insurer or can be obtained from the downloads page on this site.
The completed claims form, along with the appropriate original receipts and invoices should then be sent to the claims department of the insurance company as soon as possible (many companies will only accept claims submitted within a certain time from treatment being received - generally six months).
Upon receipt, the claims department will assess your claim and refund eligible payments either by cheque or bank transfer. They may however require further medical reports or information before they will make the payment.
Should treatment be required on an ongoing basis, new claim forms aren't necessarily required for each set of bills and receipts as long as the insurer is advised that they relate to an existing claim. It is however possible that if the treatment continues longer than six months the insurer may require either a new claim form or an up to date medical report (which they may not be willing to pay for).
Andrew Wilson
Sales & Business Development Director
13th February 2009
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